Turbine energy recovery is a process energy saving technology, and understanding turbine efficiency has important operational and economic benefits for the operator of a power plant. There are three main areas of research into turbine energy efficiency: the structural performance of the turbine itself, the configuration of the recovery device and the regulation of operating conditions. This paper summarizes recent research advances in hydraulic turbine energy efficiency improvement, focusing on the design factors that can affect the overall efficiency of a hydraulic turbine. To quantify the impact of these factors, this paper investigates the effects of surface roughness, flow rate, head and impeller speed on overall efficiency. Methods for optimizing improvements based on these design factors are reviewed, and two methods, the Box–Behnken Design method and the NSGA-II genetic algorithm, are described with practical examples to provide ideas for future research.